COVID Chronicles: To Mask or Not To Mask – Should It Be A Question Now?

We continue our COVID Chronicles series. In this episode, Vince continues and expands on the mask question.

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It’s widely known now that the primary source of transmission of the SARS-CoV-2 virus is from “contact with respiratory droplets”, which makes mask use a decent idea in principle; it also makes physical distancing, isolating, and hand hygiene logical. 

Why?

But from the practical beginning of the pandemic in the US, to the present day, I have yet to see any nationally-recognized healthcare official, any Federal or state-level government official of any party, ideology, or stripe, come out and give a clear explanation to the American people of why the measures recommended, make any kind of sense. 

What Redfield, Fauci, Birx, Trump, Pence, or anyone else nationally recognized and likely to be listened to, should have gotten on a nationally-televised news conference early on in the pandemic and made clear the following points about infection control efforts that were, in fact, recommendations not orders in the beginning. 

What Should Have Been Said

The news conference should have gone something like this:

“This is going to be really bad and millions could be infected if we don’t do something.  Right now, we don’t know everything we need to know about this new virus, so we don’t have a medication to treat the disease this virus causes, we don’t have a vaccine.  We believe it’s like SARS-1 but much more contagious.  You will likely catch it from coming in contact with respiratory droplets from infected people or contaminated surfaces.  Right now, don’t have a way to detect infected people en masse. 

The best things we can advise people to do right now are the following.  The best thing we all can do is to keep our hands clean using either hand sanitizers or better still, soap and water; and if you touch any potentially contaminated surface, avoid touching your mucus membranes – the eyes, nose, and mouth – until you’ve cleaned your hands.  This is good advice for any potential contaminant, and should provide us good protection against this virus. 

Stay home, away from other people as much as possible, if you’re sick, so you don’t pass the virus to other people.  Obviously if you’re in distress, go to your nearest hospital.  When in public, if we keep a minimum 6 foot distance from other people, that may reduce your risk of coming in contact with respiratory droplets from others. 

Wearing some type of protection for the mucus membranes, whether a facial shield or a standard disposable surgical mask, or better still, a well-fitting “N95” mask, will definitely reduce the risk of you spreading the virus to others, and may give you some protection against breathing in infected particles from others.  A homemade or similar cloth-type mask should be your last resort if you can’t obtain an N-95 or surgical masks.  These masks need to be fitted properly, so if you’re unsure about how to do that, please contact your primary care provider or a qualified Registered Nurse. 

Now please understand: none of these measures is foolproof, and you may still contract COVID-19 even by doing everything we’re saying, but these measures are the best we can do at this point in time, so we’re asking everyone to do everything possible to not only avoid catching the virus, but also to avoid spreading it to others if you become infected.”

– Author’s Version of White House Press Statement that should have been made

The Wrong Message

That’s what should have been said.  But no one said it.  All the American public was left with early on, was the impression that all we needed to do was stay away from other people, use gallons of hand sanitizer and miles of Clorox sanitizing wipes, and wear a cloth mask everywhere, and we’ll all be safe and secure, and no one will get COVID-19 disease. 

So everyone got the wrong message, and didn’t get information about why all the recommendations were being made.  For all that was said, it boiled down to the fact that what the public heard from public health officials and politicians was “do this and you’ll be safe”.  Certainly, this early fear about the virus brought about all the panic buying and subsequent long-term shortages of sanitizing products, paper towels, and similar products. 

It also created a cottage industry to take firm hold: decorative cloth mask manufacturers. 

And all that, coupled with consistently inaccurate and completely impotent recommendations from the CDC Director which amounted to no clear direction from the CDC about what state departments of heath were supposed to do, led every state to do whatever they thought was right.  While various states took the recommendations that were trickling out from various sources in the CDC as “guidelines” and encouraged various actions and activity restrictions, other states – notoriously Pennsylvania, New York, New Jersey, and California (among others) – mandated face mask use at all times in all circumstances, often under criminal penalty of fines and imprisonment for non-compliance. 

Explanation Needed

Yet no one – ever – even bothered to couple a mask mandate with a clear and thorough explanation of why masks were recommended, let alone what they did and (more importantly) didn’t do, and how to use them.

I’ve said this so often that my patients and staff can probably recite it blindfolded: Mask mandates in and of themselves, are precisely like a parent sternly warning little Timmy “don’t you dare touch that hot stove” without telling little Timmy what would happen if he did.  And just like little Timmy touching the hot stove just because his parent told him “don’t touch”, mask mandates have elicited the exact same response in many Americans. 

Mask Mandate Madness

A state or Federal government official says to Americans “wear a mask everywhere, OR ELSE!” but doesn’t explain why the mask will help, nor indeed warning that the mask itself is no “Jesus Christ” and won’t save them from ever contracting the virus. So, many Americans refused to comply with the government edicts, likely solely because the government told them they had to do it, and threatened the liberty or freedoms if they didn’t. 

Some went so far as asking for excuses or waivers from mask mandates based on medical reasons – though a number of people had no legitimate medical reason for not using a face mask. 

I personally have fielded a good number of such requests last year; and while many of them were legitimate (there certainly are legitimate medical and psychological reasons for not using a consistent face covering) a few were unfounded and I had to deny the request.  I’m certainly not going to lie for anyone who wants to claim they have a medical reason as an excuse for simply not following the recommendations from the WHO and CDC.

Straight Talk about Masks

Certainly one of my biggest pet-peeves throughout this pandemic, has been this misunderstanding about what masks can and can’t do, and why people should use them if possible, despite their drawbacks.  So, let me set this straight.

Recall our previous discussion on masks where I noted May 2020 study that showed that “surgical” or “procedure” masks “were not effective in reducing laboratory-confirmed influenza transmission”. Nonetheless, certain masks, used the proper way, can afford SOME protection against a person WITH a contagion from spreading it to OTHERS.

A face mask is primarily intended to minimize any bacteria, virus, or other contaminant in the wearer’s mouth or nose, from being expelled into the air/the environment around the wearer. This is the primary reason why surgeons, nursing staff, and other healthcare staff wear such masks in surgical suites and during sterile procedures – in order to reduce the risk of any type of non-sterile contaminant from the wearer of the mask from contaminating the sterile field of the patient.  PERIOD. 

No one wearing surgical masks in an operating suite gives any consideration to their mask “preventing” them from inhaling a contaminant from either the patient or someone else in the room, because that’s not what the mask they wear is for.  Consider also that ORs typically are designed with special air filtration systems – again to minimize the risk of sterile-field contamination.  So let’s consider the “but doctors wear masks in the operating room” misunderstanding for mask use, completely debunked.

Currently Available Mask Types

Let me give an overview of the different types of masks that are available for people to use.

N95 and KN95 Respirators

While it is true that certain types of face masks (particularly N-95 respirators) will provide a greater level of protection against the wearer inhaling viruses, bacteria, fungi, or other particulates/contaminants, they cannot prevent 100% of any contaminant from being inhaled by the wearer. However, as far as highest efficacy is concerned, the N95 is the best.

N95 respirators (they’re not technically called “masks”) filter out at least 95% of aerosol particulates. While “surgical” N95 respirators probably wouldn’t (or shouldn’t) be available for the general public, the more readily available type is the “KN95” which is the Chinese version of N95 respirators. But we have to be careful: N95 respirators have to meet strict requirements for filtering bacteria and viruses and be certified by the National Institute for Occupational Safety and Health (NIOSH).

KN95 respirators technically should still do the same thing, but from the beginning of the pandemic when panic buying of anything mask-related was taking place, this opened up a whole range of unqualified “knockoffs”, and certainly some people who thought they were perfectly safe using a knockoff KN95 still contracted SARS-CoV-2.

Procedure/Surgical Masks

Standard disposable manufactured face masks, commonly called “procedure” or “surgical” masks, have never been certified to provide significant protection against a wearer inhaling contaminants, but they do provide adequate (again not 100%) protection against contaminants from the wearer being expelled into the atmosphere around the wearer, primarily because of their standardized manufacturing process.

This process creates multi-layer tight weaving of the fibers, helping to trap nearly all large particles. Additionally, a decent amount of microscopic particles can be held along the inner portion of the mask since it would typically be more moist with water vapor from breath, thus allowing the water droplets to act as a secondary level of particulate-trapping.

However, these type of masks are meant to be disposable or “single-use-only” in general healthcare use. Unfortunately because of the early-pandemic lack of supply of procedure masks, people were reusing them which lessened their effectiveness the longer they were in service.

It’s also been floated by the CDC that people “double-mask” by using two procedure masks or a cloth mask over a procedure mask. Sadly, this is unsound advice directly from the top (there’s that damn Redfield again) which is impractical on various levels and, given the improper way that the majority of the public use and handle masks, won’t make much a difference in protection anyway.

Cloth Masks

Compared to the other types above, cloth masks provide only minimal protection, depending both on the material and the way they’re worn and used. Cloth masks are just that: cloth (or neoprene which is difficult to breathe through).

Because of a lack of standardization, and really bad advice from the Trump administration and then-CDC Director Redfield, early cloth masks were literally made from anything people had handy. I’ve even seen some people wearing a cloth mask clearly made from an old stained T-shirt and rubber bands for ear loops, taped to the ends of the cloth!

To this point, I recall when grocery stores had the one-way aisle thing going (another completely idiotic concept since the virus won’t care which way you walk down an aisle). I saw one little old lady wearing a face covering which was actually a knitted scarf. You could literally shove a Peanut M&M through the holes between the material. She obviously thought she was really well protected when she was shopping. I don’t know, but my guess is she succumbed to COVID19 early on.

Since the early days of the pandemic, enterprising Etsy-type small business owners and con artists created a cottage industry of making and selling cloth masks in all types of cloth patterns and colors. While at least these manufactured masks had some standardization to them, the problem is that they are all still made of cloth and the spacing in between the fibers of any kind of standard commercially-available cloth will always be too large to trap nearly all viruses and some bacteria.

Doing It Wrong

This brings up the big problem: people haven’t been using masks correctly. 

While I won’t take the time to outline exactly how to fit a procedure mask or an N-95 respirator mask (consult your medical provider or a Registered Nurse who can advise you how to do this or refer to the CDC page that offers much useful information), the fact that no one, on a national, completely public level ever took the time to explain how to fit a mask, how to keep from cross-contaminating yourself, etc., people have become extremely lazy about mask use. 

Some of the misuses and mishandling of masks, thus negating the protection of a mask and increasing risk of infection are:

• Constant re-use of procedure masks which are only designed for single-use and intended to be discarded after that single use
• Consistent re-use without sanitizing of cloth/”decorative” masks
• Hanging potentially contaminated masks on one’s rear-view mirror (one of my favorites of the disgusting habits people do)
• Touching products in a store before and/or after adjusting a mask
• Ripping a mask off as soon as one exits a building without sanitizing hands before or after

Even the practice of wearing gloves constantly while shopping, pumping gas, driving, touching pens and pencils, etc., is horribly problematic. The constant cross-contamination that people are doing because they’ve not been educated on how to minimize cross-contamination or how to properly use a facial covering (or gloves for that matter), is enough to give any self-respecting infection control professional a fatal heart attack. 

Unfortunately, we’ve gotten into this mindset of playing a shell game, just putting a mask on in public situations and places that “require” mask use, and shedding it as soon as we’re out of a building or out of sight of someone who might say something about not having a mask on, and reusing that same old mask over and over again while we play this game just so we “look good.”

A Mask Isn’t Jesus Christ

At the end of the day, we all need to realize the fact that a face mask is a tool, not a salvation, and people should not treat a mask (or gloves for that matter) as their personal savior against ever contracting COVID19.  It is only one of various recommendation that people should use when possible to minimize their risk of contracting SARS-CoV-2, but people should not be persecuted, prosecuted, or marginalized if they do not or cannot use a mask. 

Consider this: if a face mask (of any type) were a total salvation and protection, and we know that since the pandemic began, hundreds of millions around the world have been using masks in compliance with WHO, CDC, and other national, state, or local agency face covering recommendations, why are millions upon millions of them still contracting COVID19 disease, and why is the pandemic not over already?  The answer is simple: a mask will not save you. 

You need to practice proper hygiene, employ cross-contamination avoidance measures, use face coverings when possible, keep a distance from those known or suspected to be SARS-CoV-2 positive, and stay home/isolated as much as possible when you’re sick.  No single effort will protect you 100%, neither will doing all the measures protect you 100%.  But doing all possible measures will give you a much higher level of protection than doing nothing at all.

And thus we come to the big demon in the land: the vaccines… next time, please check back in.

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Next: War Against The Truth (The Vaccine Wars, Part I)